ACT 1 Actor's Registration Form
Actor's Name
First Name
Last Name
Sessions Attending
Finding Nemo (June 8th - June 27th)
Wizard of Oz (July 6th - July 25th)
SIX
I will be utilizing Morning/Afternoon care
Yes
No
Actor's T-Shirt Size
School's Name
Grade Level
Parent/Guardian's Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your actor have any allergies that we need to be aware of?
Is there any medical conditions or additional information we need to be aware of?
Back
Next
Emergency Contact
Emergency Contact Name
First Name
Last Name
Relationship to Actor
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Back
Next
Authorization Form
Please list the name of those that are authorized to pick-up your actor outside of full intensive dismissal time.
Authorized Adult's Name 1
First Name
Last Name
Authorized Adult's Name 2
First Name
Last Name
Authorized Adult's Name 3
First Name
Last Name
I give permission for my actor to walk or bike on their own for dismissal.
Yes
No
Back
Next
Agreements and Releases
I understand that my deposit and tuition paid are non-refundable and will not include tickets to the final performance.
I understand
I do not understand
I, as the parent/guardian, grant permission for my child to be photographed and/or recorded on video while participating with Act 1 Theatre & Invision Theatre Company. I understand that these photos/videos may be used for promotional purposes, including but not limited to social media, websites, advertisements, and printed material. I acknowledge that no compensation will be provided for the use of these images or recordings.
Yes, I grant permission
No, I do not grant permission
I, as the parent/guardian, understand that participation in Act 1 Theatre's Summer Intensive may involve physical movement, including but not limited to acting, dancing, stage movement, and the use of props and equipment. I acknowledge that while all reasonable precautions are taken to ensure safety, there is a risk of injury inherent in participation in these activities. On behalf of my actor, I voluntarily assume all risks associated with participation. I hereby release, waive, and discharge Act 1 Theatre & Invision Theatre Company, it's owners, staff, volunteers and affiliates from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury that may be sustained by my child while participating in the program. In the event of an emergency, I authorize Act 1 Theatre and Invision Theatre Company staff to obtain medical treatment for my child if I cannot be reached. I understand that I am responsible for any medical expenses incurred. I certify that my child is physically able to participate in Act 1 Theatre Intensive activities and that I have disclosed any relevant medical conditions on the registration form. By agreeing below, I acknowledge that I have read, understand, and agree to the terms of this waiver.
I agree
I do not agree
For the safety of all participants, children will only be released to individuals listed on the authorized pick-up list. A valid photo ID may be required at pick-up. Intensive dismissal is at 2:00 each day. Parents/guardians are expected to pick-up their child on time. Act 1 Theatre staff will supervise students for a brief grace period of 10 minutes after dismissal. Families will be charged a day of Extended Care ($20) if actor is not picked up by 2:10. If an actor is enrolled in Extended Care and is not picked up by 5:30 and we are unable to reach a parent/guardian or emergency contact, appropriate authorities may be contacted for the safety of the child. By acknowledging below, I agree to the above listed terms.
I understand
I do not understand
I understand that my child will have the option to purchase snack and participate in Pizza Fridays. I hereby certify that I have communicated any allergies/medical conditions relevant. By agreeing below, I am allowing my child to purchase snacks through Act 1 Theatre Summer Intensives and participate in Pizza Fridays.
I agree
I do not agree
Submit
Should be Empty: